Alcohol, Drug Abuse Key Factors in Mortality Rate Increase

Rising Death Rates Due to Drugs, Alcohol, Liver Disease

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For the first time in decades, the mortality rates for white men and women in the United States has increased rather than decreased and alcoholism and prescription drug abuse are cited as key factors in the turnaround.

After decades of declining mortality rates at about 2% per year from 1978 through 1998, a National Institute on Aging (NIA) analysis reported an increase in mortality rates for non-Hispanic whites of about a half percent per year beginning in 1999.

The three causes of death that contributed to the dramatic turnaround in mortality rates for midlife whites were suicide, drug and alcohol poisoning, and chronic liver disease and cirrhosis.

Reversal in Decades-Old Mortality Declines

Princeton University researchers Anne Case, Ph.D., and Angus Deaton, Ph.D., used data from individual death records, the Centers for Disease Control and Prevention, the US Census Bureau and other sources to make their analysis.

From 1978 through 1998, mortality rates for middle-aged whites fell by an average of 2% per year not only in the United States but also in France, Germany, Canada, Australia, Sweden, the United Kingdom, as well as all the European Union countries.

The decline in mortality rates continued to decline in other "rich countries" after 1998, except in the United States, the researchers found.

Declines in Health, Increases in Pain

The NIA researchers also found that morbidity rates increased as well for white non-Hispanic Americans.

Their analysis found self-reported declines in the following:

The analysis found self-report increases in the following:

No Other Groups Affected

The midlife mortality rate reversal was confined to white non-Hispanics only.

No other group was affected. Black non-Hispanics and Hispanics in midlife continued to see falling mortality rates.

Those aged 65 and over in every racial and ethnic group also continued to see declining mortality rates after 1998.

Among white non-Hispanics in middle age, increases in mortality from suicide and poisoning increased among all educational groups, but those with less education saw the largest increases in mortality rates.

Causes Not Completely Understood

Chase and Deaton report that they only partially understand the causes for the increase in midlife mortality, but their analysis shows the key factors to be:

  • Increased availability of opioid prescription drugs
  • Increase in chronic pain (for which opioids are prescribed)
  • The economic crisis which began in 2008

Prescription Drug Abuse Epidemic

Other studies have documented the increase in mortality associated with the increased availability of opioid prescriptions for pain that began in the late 1990s.

The NIA study found that for every prescription painkiller overdose death reported, 10 patients were admitted for treatment, 32 visited the emergency room, 130 were abusers or addicted, and 825 were nonmedical users of the drugs.

Epidemic of Chronic Pain

The researchers also noted that tighter controls on opioid prescriptions prompted some to shift to heroin during a period of time when heroin prices were falling, the quality of heroin increases and heroin becoming available in areas where it was previously mostly unknown.

Although the authors of the study note that it cannot be determined which came first the increase in pain or the increase in opioid use, the epidemic of pain is real and the prevalence of chronic pain might have been higher without the availability of the drugs.

Pain itself is a risk factor for suicide, but the researchers point out that increased alcohol abuse and suicides are likely symptoms of the same underlying epidemic and have increased alongside it.

Economic Insecurity Also a Factor

Although the epidemic of pain, suicide, and drug overdoses began before the financial crisis, Chase and Deaton believe the increase in mortality rates for midlife white Americans may have ties to economic insecurity.

The researchers found that because of economic factors going back to the 1970s, many of the baby-boom generation are the first in U.S. history to find that in midlife they will not be financially better off than their parents were.

Working Class Hit Hardest

The group of current white Americans aged 45 to 54 has seen slow growth in their real median earnings, especially those with only a high school education. They have seen their stock-market-based retirement plans dwindle or even disappear, leaving them awash in financial insecurity.

Chase and Deaton are not the only observers who have linked financial insecurity to increased drug and alcohol abuse among this group, and the resulting increase mortality rates. Economists and financial advisors have also speculated on why death rates have soared for uneducated white Americans.

Breakup of Family Support

In a report "The Decline and Fall of America's Working Class," Bill Bonner editor of the Bill Bonner’s Diary wrote that:

"They can't get decent jobs. Their marriages are breaking up. Their children are raised by single parents. They drink too much. They take drugs. They've given up looking for work. They kill themselves at a startling rate."

Noah Smith, an assistant professor of finance at Stony Brook University and a freelance writer, also has speculated why this group has turned to alcohol and drugs:

"The uneducated class became a floating low-skilled labor force, which decreased the marriageability of white working-class men. That impaired family formation. A couple of decades later, the lack of family support started to take a big bite out of the emotional health of working-class whites, causing them to turn to alcohol, drugs, and suicide once they reached middle age."

A Lost Generation?

Regardless of the causes of the increase in mortality rates for middle-aged white non-Hispanics, it is clear that drug misuse and alcohol abuse are playing a key role in the increasing death rates.

That means the trend is potentially reversible because alcohol and drug abuse are treatable.

Chase and Deaton expressed concerns that those currently aged 45 to 54 will age into Medicare in much worse health that those currently in Medicare, unless the epidemic of is brought under control.

But, they wrote, "addictions are hard to treat and pain is hard to control, so those currently in midlife may be a 'lost generation' whose future is less bright than those who preceded them."


Bill Bonner. "The Decline and Fall of America's Working Class." Bill Bonner's Diary November 17, 2015

Chase, A, et al. "Rising Morbidity and Mortality in Midlife Among White Non-Hispanic Americans in the 21st century." Proceedings of the National Academy of Sciences November 2015